Cryptorchidism is a term used to describe the failure of descent of the testicle into the scrotum. This condition is common among premature boys, 33% of them, and can still be identified in full-term boys in approximately 5%. Ultrasonography can help localize inguinal testicles, while abdominal magnetic resonance imaging or laparoscopy can identify non-palpable intraabdominal testis. Hormonal treatment is indicated at 6 months of life and surgical correction is needed if hormonal therapy failed. Surgical treatment should be attempted before one year of life to achieve better fertility outcome.

00:00
In this section, we’ll take
a look at the remainder ofour male reproductive tract.
00:07
We have completed our discussion
of penile pathology here.
00:10
We’ll take a look at
pathology of testis,epididymis, and the scrotum.
00:14
Once again, picture
what these look like.
00:17
know as to where we are,so that you’re able
to clearly understandthe pathogenesis of each
one of these conditions.
00:25
Our topic at first
is cryptorchidism.
00:28
When I began the discussion,we began our male reproductiveby looking at congenital
issues embryologically.
00:35
And we looked at the testis
beginning in the abdomen andif it’s not properly pulled down by
the gubernaculum into the scrotum,this is then called
cryptorchidism.
00:45
Let’s go into details.
00:46
One or both undescended testis.
00:49
Majority of which are located
in the inguinal canal.
00:52
Can you picture that?Normally, they should be
resting in the scrotum.
00:56
However, it didn’t quite make itand the testis is stuck
in the inguinal canalMajority of them are.
01:03
Could they be back
in the abdomen?Sure.
01:05
But go with the common.
01:07
There’s impaired spermatogenesis,
as you can imagine,if the testis aren’t properly
located in the scrotum.
01:12
You need that optimum temperature
of 37 degrees, right?And if you don’t have
that 37 degrees Celsius,then it’s difficult for a male
to undergo spermatogenesis.
01:22
And so therefore –
well look for –A different physiology
question of this would beif you have a male that’s in different
temperatures, right?Environments.
01:31
And so therefore, may not be the
most conducive to spermatogenesisEven for example, bicyclists
and what do they do?They sit on that seat for
hours and hours and hours.
01:42
And that disrupts
proper spermatogenesis.
01:45
No joke.
01:46
Meaning to say that even lifestyle
and the way that you lead itcould have serious
sequelae or consequences.
01:53
Presents in 1% of boys
at 1 year of age.
01:56
With increased occurrence in
premature or even Klinefelter.
02:00
Our topic cryptorchidism,
undescended testis,1 in 1. 1% in 1 year of age.
02:05
Klinefelter is big.
02:07
What does your patient with
Klinefelter look like?Picture that.
02:09
Patient, please?Long arms, long legs,maybe perhaps gynecomastia,but the jaw looks like a male.
02:19
Testosterone levels are normal
in unilateral cryptorchidismdue to unaffected Leydig cells.
02:26
So you can have the other scrotum
with it’s Leydig cells in which --You tell me as to what hormone
acts upon the Leydig cell.
02:33
Good. LH.
02:34
Responsible for
testosterone synthesis.
02:37
But descreased in
bilateral, obviously.
02:39
So here, if you have bilateral
undescended testis,then the Leydig cells are not
able to properly perform.
02:45
So therefore, you would have
suboptimal levels of testosterone.
02:49
Is that understood?That’s important.
02:52
Inhibin B levels are
depressed with increasedLH and FSH and there’s increased
risk of germ cell tumors.
02:59
These two bulletpoints are very,
very important for you to know.
03:02
If you don’t have proper –I’m going to bring you back
to physiology real quick –tell me as to where inhibin
B comes from in the male?Good.
03:11
Sertoli cells.
03:12
So if you don’t have proper
descent of the testis,then the sartoli cells are not able
to properly release inhibin B.
03:19
Inhibin B works on,
if you remember,the hypothalamo–pituitary axisand so therefore,
normally it inhibits.
03:27
So if you don’t
have the inhibin B,you’re going to increase
your gonadotropin hormones,increase LH and FSH.
03:33
Make sure you know the feedback.
03:35
Every little point
here has a story.
03:39
And the last little point
with cryptorchidismis the fact that your
male is now prone to --the most common family of testicular
tumors are germ cell tumors.
03:50
Of all the germ cell tumors,
which is the most common?Seminoma.

About the Lecture

The lecture Cryptorchidism by Carlo Raj, MD is from the course Male Reproductive System Diseases.

Included Quiz Questions

Which of the following is a correct statement regarding cryptorchidism?

Increased risk of germ cell tumors

Increased risk of squamous cell cancer

Prematurity significantly decreases the risk

It is present in 10% of boys at the age of 1 year

Testosterone levels are always abnormal

The descent of the testes follows the descent of which structure?

The gubernaculum

The caudal part of the testicle

The cephalic part of the testicle

The epididymis

The urogenital sinus

Plasma testosterone levels will be decreased in which condition?

Cryptorchidism of both testicles

Cryptorchidism of one testicle

Hypospadias

Epispadias

Priapism

Author of lecture Cryptorchidism

Carlo Raj, MD

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